Diagnosis of cancer of the renal pelvis or ureter

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer of the renal pelvis or ureter usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as cancer of the renal pelvis or ureter. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of cancer of the renal pelvis or ureter.

The following tests are usually used to rule out or diagnose cancer of the renal pelvis or ureter. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Health history and physical exam

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

symptoms that suggest cancer of the renal pelvis or ureter, such as blood in the urine (pee)

Urinalysis and other urine tests

A urinalysis examines your urine. It finds and measures substances in a sample of urine, such as blood, bacteria and cells. It is often one of the first tests done to check for abnormalities in the urine and problems in the urinary tract.

Blood in the urine (hematuria) may mean there is bleeding in the urinary tract, which could be caused by cancer. Nitrites in the urine may mean you have a urinary tract infection (UTI).

A urine culture tests a sample of urine for bacteria and other germs that can cause an infection. In a lab, the urine is placed in a special substance where germs can grow. After a few days, the sample is examined under a microscope to check if bacteria and other germs have grown. A urine culture is done to check if an infection could be the cause of symptoms.

Urine cytology studies the cells in a urine sample or washings of the urinary tract (collected during a ureteroscopy or cystoscopy when rinsing parts of the urinary tract with salt water). Urine cytology can be used to look for abnormal cells, including cancer cells.

Complete blood count (CBC)

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC may be done to check for anemia from long-term bleeding from the urinary tract. It may also be used to check for an infection.

Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find abnormalities. Blood chemistry tests used to help diagnose and stage cancer of the renal pelvis or ureter include the following.

Kidney function tests measure how well the kidneys are working. Higher levels of certain chemicals may mean that there are kidney problems or a blocked urinary tract.

Alkaline phosphatase (ALP) is an enzyme found throughout the body. The highest amounts are found in the cells of the bone and liver. Increased levels of ALP may mean the cancer has spread to bone or the liver.

Liver function tests (including ALP) measure how well the liver is working. Higher levels of certain chemicals may mean that the cancer has spread to the liver.

Ureteroscopy and cystoscopy

A ureteroscopy uses a thin tube with a light and lens on the end (called a ureteroscope) to look inside the ureters and renal pelvis. It is used to look for any tumours or abnormal areas. Biopsy samples may be taken during a ureteroscopy. A ureteroscopy is done when there is blood or abnormal cells in the urine.

A cystoscopy will also be used for the doctors to look inside the bladder and urethra. It is done like a ureteroscopy, except the doctor will look at the lower urinary tract. It can be done at the same time as a ureteroscopy.

Biopsy

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample. Small tumours and biopsy samples from the renal pelvis or ureter may be removed during a ureteroscopy or surgery.

Retrograde pyelography

Retrograde pyelography is a test that makes images of the urinary system, including the kidneys and ureters. A dye is injected directly into the urinary system through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the ureters or kidneys.

CT scan

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if cancer has spread to lymph nodes, the liver or other organs and tissue around the renal pelvis and ureter. A CT scan of the chest may be used to check if cancer of the renal pelvis or ureter has spread to the lungs.

CT urography makes images of the urinary system. A dye is injected into a vein and concentrates in the urine. A CT scan is done as the urine (with the dye) moves through the urinary tract. The images can help look for tumours.

MRI

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures. An MRI may be used to check if cancer has spread to organs or areas outside the urinary tract.

Ultrasound

An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to check if cancer has spread to other organs or areas in the pelvis and abdomen. An ultrasound can also be used to check the health of the kidneys.

Chest x-ray

Bone scan

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to check if cancer has spread to bone. It is usually only done if you have symptoms such as bone pain or if the level of ALP in the blood is high.

Questions to ask your healthcare team

A description of the extent of cancer in the body, including the size of the tumour, whether there are cancer cells in the lymph nodes and whether the disease has spread from its original site to other parts of the body.

Stages are based on specific criteria for each type of cancer.

The process of determining the extent of cancer in the body based on exams and tests is called staging.

chronic

Occurring slowly, lasting a long time or progressing very gradually.

urinary tract

The pathway that urine takes from the kidneys to the urethra.

The urinary tract includes the renal pelvis in the kidneys, as well as the ureters, bladder and urethra.

anemia

A reduction in the number of healthy red blood cells.

urinary system

The group of organs that make, collect, store and pass urine out of the body.

The urinary system includes the kidneys, ureters, bladder and urethra.